Trigger finger is a pathology of the flexor tendons caused by inflammation of the tendon or its sheath, leading to pain, nodules, fibrosis, and limited mobility. Surgical treatment aims to release the space at the level of the A1 pulley, either through longitudinal opening (the standard technique, but associated with recurrence rates of approximately 7.7%) or through complete resection, an emerging approach that may reduce recurrences and the need for reoperations. However, comparative data remain limited, justifying further investigation. This project therefore aims to compare these two surgical techniques to determine which one results in the lowest recurrence rate and to assess their functional outcomes (pain, range of motion). The primary hypothesis is that A1 pulley resection reduces recurrences after one year, while the secondary hypothesis is that there is no significant difference in postoperative pain or mobility.
Patients requiring surgical intervention for the treatment of a trigger finger
Patients able to provide informed consent
History of surgery for trigger finger correction on the same finger
Patients requiring simultaneous surgery for more than one trigger finger
Parallel
Longitudinal incision
Procedure/SurgeryA longitudinal incision of the A1 pulley performed to open the pulley, thereby reducing the pressure on the inflamed tendon and facilitating its gliding during finger movements.
Complete resection
Procedure/SurgeryFully removing the pulley in order to eliminate friction between the tendon and its fibrous band
Compare trigger finger recurrences between longitudinal A1 pulley release surgery and complete A1 pulley resection surgery
The diagnostic method will be clinical evaluation. It will be based on the patient's clinical history, including the presence of a painful 'click' during finger movement, a finger that occasionally locks in flexion, pain over the A1 pulley, and/or a palpable nodule at the level of the A1 pulley. The primary outcome will be assessed by an independent, blinded evaluator who did not participate in the surgery and is unaware of the patient's allocation. If necessary, the evaluator will verify the limitation by placing the dorsal surface of the patient's hand on the table and asking the patient to make a fist (flexion) and then open the hand (extension): the inability of the affected finger to remain in a flexed position will confirm the diagnosis. No score, tool, or scale is required for diagnosis, as recurrence is a binary variable that is either present or absent.
Persistence of pain to the operated finger
Pain will be measured using the Visual Analog Scale (VAS), which consists of a 10-cm linear paper scale with a horizontal line labeled only at both ends: '0 = no pain' and '10 = worst imaginable pain.' After the patient marks their pain level by placing a point on the line, the distance in millimeters will be measured with a ruler by the blinded evaluator. All evaluators will follow the same procedure to ensure inter-observer consistency."
Range of motion of the operated finger
The measurement tool for range of motion will be a goniometer, an instrument that allows precise measurement of the finger's flexion and extension angles.
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